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In the face of increasing bacterial resistance to drugs, medical professionals have turned to tiny particles of silver as a weapon against infection. But unregulated use of nano-silver means this too may become ineffective.

FOR NEARLY A CENTURY, we have used antimicrobials to wage a war on bacteria. We have learned to fight off these 'enemies' by using stronger and stronger antibiotics and other antimicrobial weapons. As bacteria have found ways to resist the lethal effects of one antimicrobial weapon, we have discovered and unleashed new antimicrobials.

However, there is now a real worry that we may be running out of options to tackle antimicrobial resistant (AMR) bacteria - the superbugs - those with resistance to a variety of different antimicrobials. If the problem of superbugs continues to worsen, it will - in effect - result in a return to the pre-antibiotic era, where a bacterial infection from a simple operation, a commonplace disease, or even a scratch could result in the loss of a limb or even the loss of a life.

In response to this looming health crisis, Australian scientists and health care experts have made clear recommendations for more than a decade. In order to maintain the effectiveness of antimicrobials in our hospitals - where they are needed most - we need to seriously reduce their usage elsewhere.

In some clinical settings, the medical community has been turning to silver as an antimicrobial of last resort to line wound dressings, catheters, stents and other sensitive clinical surfaces. However, as with antibiotics, the use of antimicrobials like silver ultimately drives the selection of bacteria with genes that make them able to withstand the usually toxic effects of silver. Thanks to the promiscuous nature of bacteria, they regularly share small pieces of DNA containing whole cassettes of genes which confer resistance to multiple antimicrobials. Indeed, there is already evidence of bacterial resistance to silver alongside antibiotic resistance in many clinical settings.

Relatively new developments in nanotechnology now allow the production of silver nanoparticles - commonly referred to as nano-silver - which can be embedded in a range of materials and devices. Because of its extremely large relative surface area, nano-silver is a much more potent antimicrobial than bulk silver.

Despite its clinical importance, hundreds of companies around the world have seen a marketing advantage in including nano-silver as an ingredient in everyday products. Nano-silver is now used as an antimicrobial in toothpastes, pet shampoos, fabric softeners, bath towels, cosmetics, deodorants, baby clothes, baby bottles, refrigerators, food storage containers, kitchen cutting boards, underwear, ATM buttons, industrial disinfectants, agricultural pesticides, handrails for buses and more.

Here in Australia, many people already come into contact with nano-silver everyday. Antimicrobial experts such as Professor John Turnidge have warned that using such a powerful antimicrobial in these everyday products is not only unnecessary, but dangerous (pdf).

Concerns have been raised that the widespread non-clinical use of nano-silver as a surface antimicrobial will compromise the microbial diversity of our immediate environment (eg skin) and wider environment (eg soil and water). This in turn will eliminate the vast numbers of protective microbes, and allow the flourishing and spread of antimicrobial resistant bacteria. Furthermore, experts now warn that bacteria that are resistant to nano-silver are often also resistant to other antimicrobials and antibiotics.

In response to these warnings, some companies have claimed we have used silver for thousands of years without any demonstrated harm. However, the quantity of nano-silver particles currently in use, the strength of their antimicrobial properties, the contexts of their use, and the current antibiotic resistance crisis are unprecedented.

The good news is that seriously restricting our uses of antimicrobials has been proven to lead to lower levels of antimicrobial resistance. We only need look at how the restricted use of quinolone antibiotics in both humans and animals in Australia has maintained low levels of bacterial resistance, compared to elsewhere around the world. Sweden also has some of the lowest levels of AMR in the world, thanks to massive education and surveillance programs that were launched in the mid-1990s.

But while Australian scientists and health care experts have recommended for more than a decade that we need to reduce overuse of antimicrobials, their warnings have not been heeded.

The Australian Senate is currently investigating why so few of these expert recommendations have been implemented, and what effective steps can be taken.

More than a decade of relative inaction in regulating the use of both antimicrobials and applications of nanotechnology by our Federal Government has contributed to the crisis we are now faced with. But this senate inquiry offers a chance to get back on track.

The time for stalling is over. Urgent regulatory action is needed if we are to preserve the effectiveness of available antimicrobials and ensure our nation's health.

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Comments (16)

floss :

17 Feb 2013 12:34:11am

Antibiotic resistance is a natural part of evolution, it is the genetic change within an organism which allows that organism to survive. A form of cyanobacteria, a blue-green algae, was one of the first life forms known to exist. Yet when this bacteria multiplies in our water supplies it presents a risk to human health and we avoid it.

Similarly, humans have acquired resistance to many things in our environment that are harmful to our health. I perceive a real danger of us losing this natural ability if we repeatedly impose an external remedy to take its place.

Is the greater problem going to be the increasing resistance of super bugs to our known antibiotic agents, or of our self imposed inability to allow our own immune systems to respond appropriately?

Either way, only using antibiotic agents in the prescribed way when needed to combat an immediate threat is a sensible strategy. That is, unless profits really are more important than public health.

crank :

14 Feb 2013 9:07:01pm

As far as I am aware there has been no research to establish the safety of nano-particles. These are so small that they are able to migrate into cells and even cell organelles like mitochondria, ribosomes and cell nuclei. Apparently, in the interests of profit maximisation, the religion of our end-stage capitalist dystopia, they, like GE crops, have simply been declared 'substantially equivalent' to something or other- perhaps to 'a mother's love'. However, it is already known that workers in carbon nano-tube applications have been found to have pleural granulomas, perhaps a precursor to malignancy, such as mesothelioma. We are, I'd guess, working on Murphy's Principle, preparing another asbestos scourge, or worse, for all our backs. I think that it just might be a wee bit disruptive for our cells and their function to have particles of silver, probably unencountered previously by the cell over aeons of time, suddenly cluttering up the works.

robbieo :

13 Feb 2013 6:07:42pm

surprise surprise,

its a well known fact that the drug companies that drive the third biggest industry on the planet next to the war industry ( worldometres ) has a lot to loose out of their bottom line when natural remedies out perform manufactured drugs.

since the 40's the mass production of food through agricultural technologies and chemical farming ,mineral and vitamin content has been diminishing (see reports dating back to the 50's).

colloidal minerals are essential to all life on the planet because by their nature they can be absorbed into the blood stream,through the cell wall, and therefore feed cells . silver was a natural part of our soil like iron and zinc and we all know the effects of their absence so we add them artificially to foods .

the drug industry wants you to think that anything that they didn't make is not scientifically proven and should not be used ...ha ha ..next hing you know they they will be telling you to remove your silver rings...

the research into colloidal minerals and metals is well established,but ,unfortunately they are so cheap and readily available the drug companies don't know how to make money out of them so they will do what they can to have them controlled by patent or banned eg. comfrey , pennyroyal ,etc

i have seen cases of people with chronic golden staph infections, after years of agony and antibiotic abuse to their system resulting from hip surgery etc.,cured after 1 month and completely infection free after 3 months for a total cost of about $5 worth of pure colloidal silver.

colloidal silver kills aggressive systemic bacteria ,yeast and fungus by disabling the oxygen absorbing enzyme of these single cell organisms allowing them to be flushed out of our system as normal waste . pure silver is not toxic and has no cumulative effect..and no it does not turn your skin blue....

Gregory Crocetti :

14 Feb 2013 11:31:27am

I'm sorry, what's the surprise?Friends of the Earth have no relationship with the pharmaceutical industry, so it's unclear why you draw this strange link.

Given the potent antimicrobial properties of silver, I don't find it surprising that colloidal (nano) silver is able to potentially achieve positive outcomes for humans. But what about the downstream effects of this silver?Yes, there are trace amounts of silver in our soils, but silver is not "added artificially to our foods". At least not in any way acknowledged by the food industry.At current rates of extraction and use, silver - in all it's forms and sizes - poses a range of threats:- increasing levels of general antimicrobial resistance,- increasing levels of specific silver resistance,- increasing rates of childhood allergies,- bioaccumulating in plants and animals,- disrupting whole ecosystems in soil and water bodies,- disrupting biogeochemical cycles, particularly nitrification and nitrogen fixationGiven the potential benefits in hospitals and risks outlined above, how can we possibly justify current widespread rates of silver usage?

bob :

14 Feb 2013 3:52:50pm

"cured after 1 month and completely infection free after 3 months for a total cost of about $5 worth of pure colloidal silver.", exactly, that's why we should use all antibiotics (including silver) only when necessary as in the case you give. If that patient had been dosing themselves with silver for every little thing, then the staph infection may have turned out to be resistant. I think you missed the point of this article, it was not about patenting silver and it's uses, it was about moderating it's use to protect it's effectiveness.

blax5 :

13 Feb 2013 4:02:46pm

The fact that the companies no longer research antibiotics has also been a concern for me. From the business point of view you can't blame them. What's not viable needs to be discarded, that's the mantra.

With the significant drive in the US for the green weed, I have developed the idea that this business should be allocated to big pharma. They have the systems in place to control dispensing, which can then be extended to Mary Jane.

For getting this business opportunity they ought to be compelled to use a certain percentage of their profits for antibiotic development. This is a once in a lifetime opportunity to kill two birds with one stone. Nothing else moves, if someone else has a better idea, let's hear it.

TimP :

I think the issues with antibiotic resistance and antimicrobial resistance are being simplified and beat up.

While yes, most species of bacteria have a resistance to one kind of antibiotic or another, more intelligent use of antibiotics is making the future slightly brighter.

Drug companies are hesitant to pour millions into research for antibiotic drugs which will most likely be used for one course and potentially become obsolete if a resistance develops.

On the plus side penicillin is still used widely and many many species of bacteria are susceptible. Gentamicin is similarly still very effective against the majority of bugs it is used for (although it does have side effects which may limit its use).

The original antimicrobials are heat and salt. Still effective. Alcohol is always going to be effective as well.

The key is not to freak out about this, but to become more intelligent in our use of these resources. Increasing investment into research and increasing our arsenal would also be extremely useful.

Helen Goodman :

13 Feb 2013 12:30:46pm

Thank you (I think) for the timely warning about the overuse of silver as an antimicrobial agent. This overuse, along with the overuse of antibiotics in the production of food is alarming. A leading retailer trumpets its use of "no added hormone" meat, yet the crucially important use of antibiotics is ignored.

How can we get the message out before the canary in the coalmine "carks it"?

in god we trust lol :

13 Feb 2013 10:35:29am

No use closing the stable door after the horse has bolted! Tell this to the Chinese who will probably cause the next pandemic because of their unbelievable use of anti-biotics in agriculture...which they then export here in food-stuffs...only when the medical profession embraces pro-biotics will this change. It is the arrogance of the medical profession/linear scientific thinking which caused this problem in the first place.

Andrew C :

This article is about (essentially) anti-microbial resistance and the overuse of anti-microbials. Pro-biotics have nothing to do with microbes or antibiotics/anti-microbials.

Also, just for your interest, pro-biotics are not scientifically proven to have a beneficial effect on gastrointestinal health. The claims made about probiotics have all been rejected as disproven, or identified as lacking in evidence. That's if the claims made about probiotics are not so general as to be utterly insubstantial and vague.

Probiotics belong in the long list of pseudo-science, until such time as they are able to meet evidentiary standards for the claims of health benefits.

in god we trust lol :

13 Feb 2013 11:15:59pm

Well pro-biotics are obviously the opposite to anti-biotics, the overuse of which have caused the ancient anti-microbials such as colloidal silver to be finally given an impramatur by the science-Vatican.. This silver could only be purchased in crank-like health food shops previously, certainly not in any place "approved".Problem with your list-y stuff is that lots of us already know that "pro-biotics" create stronger immunity, we dont need the Impramatur to allow us to believe.; Corresponded experience is as valid as a double-blind trial. Science will catch up one day, as usually happens.My point is that the immunity of the community in general would be vastly improved by the use of "pro-biotics"....which is a very long list actually.....than by " anti-biotics"...its conceptual as well as applied, thus reducing dependence on antibiotic medicine with its flawed paradigm of bio-stasis.

Brendan :

The core of this article is that over-use of nano-silver may generate resistant bacteria AND also reduce individual's normal microflora, the latter may be combated with probiotics.

You have provided no evidence for your statements Andrew and you are wrong. Our microflora is essential for normal development and our immune system, and antibiotics upset this - just look at this recent ABC article where probiotics were used to cure patients with gastro-intestinal infection where antibiotics had failed: http://www.abc.net.au/radionational/programs/ockhamsrazor/27poo-transplants27---the-australian-story/4501528#transcript. And probiotics help suppress stomach ulcer and cancer causing Helicobacter pylori (http://ajcn.nutrition.org/content/80/3/737.full.pdf)

Here is a good summary of microflora and biobiotics here: http://www.apa.org/monitor/2012/09/gut-feeling.aspxand wiki:http://en.wikipedia.org/wiki/Gut_flora and http://en.wikipedia.org/wiki/Probiotic

There is an absolute wealth of information on how essential pro-biotics are for human development and health; from what we acquire from birth, feeding and environment, and the influence this has on immunity and behaviour – this is not a pseudo-science (albeit exploited for commercial profit).

Gregory Crocetti :

14 Feb 2013 10:50:57am

I'm not sure if your post is a question or a comment.But many antimicrobial resistance genes have likely been around for billions of years. The problem that many modern medicine and agricultural practices continues to exacerbate is that of massively increasing the rate of bacteria (especially) swapping and collecting these resistance genes.Other factors adding to the unfolding crisis of antimicrobial resistance must include the high rates of human travel and food transportation around the world.My point here is that the growing scientific evidence into the co-selection of silver resistance alongside antibiotics also begs that we heavily restrict the new and frivolous uses of nano-silver in consumer goods like shoes, socks, hairbrushes, towels and so on. Let's save it for our hospitals.

in god we trust lol :

14 Feb 2013 11:46:11am

antibiotic resistance did not arise by itself....are you saying the medical/scientific community is not culpable for this? Genetics requires selection factors such as multi-national drug companies and their dupes the medical profession to push this evolution. Arrogance in the medical profession is exemplified by their approach to pro-biotics such as good food which isnt even touched in medical training or diagnosis or acknowledged by the drug-prescribing-automatons. Actually being in the real world gives insight into this manifest arrogance, which practitioners can never acknowledge(or even see) because it would undermine their quasi-religious status. Iatrogenesis is huge in our medical system and un-regulated, but you have to be on the other side of the doctors desk to be aware of it....and it is the stuff of jokes among we regular people...haha.

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